One of the key elements in the federally-led effort to implement widespread delivery of COVID-19 vaccines in the United States is distributing some doses to pharmacies. In a new and unique program, the Centers for Disease Control and Prevention (CDC) has partnered with 21 pharmacy networks to give COVID-19 vaccinations, which includes four networks of independent community pharmacies. But the success of this program may be limited by a reality affecting much of rural America: there isn’t a pharmacy close to many people in a large number of rural counties.
Many counties without eligible pharmacies
In a new analysis published by the Rural Policy Research Instituteat the University of Iowa, researchers found that out of 1,962 rural counties nationwide, 111 had no pharmacies eligible to administer COVID-19 vaccines. Once pharmacies not affiliated with the 21 pharmacy networks that are partnering with the CDC were excluded, the number of counties not likely to administer COVID-19 vaccines was 442. Even if all pharmacies in rural counties that offer on-site immunizations in general were to sign up to administer COVID-19 vaccines — which is unlikely if they’re not in a network partnering with the CDC — there would still be 321 rural counties with no pharmacies administering COVID-19 vaccines.
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Vaccine access limited
As shown in a Kaiser Health News article on the study, rural counties with just one or no pharmacies capable of administering COVID-19 vaccines are overwhelmingly located in the middle of the country — in a band that runs from the Canadian to the Mexican border through Montana, North Dakota, South Dakota, Nebraska, Colorado, Kansas, New Mexico, Oklahoma and Texas — and in Alaska. The article notes that 1.6 million Americans live farther than 20 miles from the nearest pharmacy, with many living much farther away, so getting a COVID-19 vaccine would represent a substantial burden for this population.
While current supplies of COVID-19 vaccines are limited enough that there hasn’t yet been a problem finding ways to administer available doses in rural counties, that may change quickly as the vaccine supply increases and health departments find themselves with enough doses for much of the population — but potentially no workable plan for actually getting vaccines to people who want them. Many rural counties lack a hospital or clinic or even a licensed doctor, so in some cases, setting up a mobile or temporary clinic may be the only feasible solution. And this would need to be done by health departments that, in many cases, have no prior experience administering vaccines.
The article notes that between 2003 and 2018, 1,231 independent rural pharmacies closed for good, leaving 630 rural communities newly without a pharmacy. Consolidation of national pharmacy chains and big-box stores opening pharmacies played a role in these closures, leaving independent pharmacies unable to compete. Many people also signed up for mail delivery of prescription drugs — something that won’t work, of course, for a vaccine.
All of this means that in much of rural America, it may take much longer than in urban and suburban areas for residents to get meaningful access to COVID-19 vaccines, potentially drawing out the misery of the COVID-19 pandemic disproportionately in these areas.
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